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LANDWES-02 KCORDILL
<br /> ,d►coRO CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY)
<br /> 12/3/2025
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT Kelly Cordill
<br /> NAME:
<br /> High Ground Insurance Services PHONE FAX
<br /> 2377 Crenshaw Blvd.,Suite 304 (A/C,No,Ext): (A/C,No):
<br /> Torrance,CA 90501 E-MAIL kcordill@unitedagencies.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURERA:GEMINI INSURANCE COMPANY 012118
<br /> INSURED INSURER B:National Speciality Ins Co 012273
<br /> Landscape West Mgmt Svcs,Inc. INSURER C:Crum& Forster Specialty Ins. 44520
<br /> 1234 North Blue Gum Street INSURER D:SafetyNational 15105
<br /> Anaheim,CA 92806 INSURER E:CenturySurety Company 36951
<br /> INSURER F: James River Insurance Co 012604
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD MM/DD/YYYY MM/DD/YYYY
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR VCGP033780 4/1/2025 4/1/2026 rl DAMAGE TO RENTED 300,000
<br /> X X PREMISES Ea occurrence $
<br /> MED EXP(Any oneperson) $ 5,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X 71 PEA LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> ANY AUTO X X GM1097601 4/1/2025 4/1/2026 BODILY INJURY Perperson) $
<br /> X OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident)
<br /> ccident $
<br /> C UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000
<br /> X EXCESS LAB CLAIMS-MADE X SE0137295 4/1/2025 4/1/2026 AGGREGATE $ 2,000,000
<br /> DED RETENTION$ $
<br /> D WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY X STATUTE ER
<br /> 4503-0363 10/11/2025 10/11/2026 1,000,000
<br /> ANY PROPRIETOR/ R/EXECUTIVE ❑ E.L.EACH ACCIDENT $
<br /> EXCLU
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> E Property CCP1302834 4/1/2025 4/1/2026 Property 232,000
<br /> F Excess Liability($3,000,000 layer) BR211981-03 12/3/202 4/1/2026 Excess Liability $ 3,000,00
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> re:Right of Way-FREEWAY ON&OFF RAMP
<br /> City of Santa Ana,it's Officers,Employees,Agents,Volunteers and Representatives are included as Additional Insured in respects to General Liability arising
<br /> out of work operations performed by or on behalf of Contractor including materials,parts,and equipment furnished in connection with such work or
<br /> operations and automobiles owned,leased,hired,or borrowed by or on behalf of Contractor when required by written contract per policy form.This coverage
<br /> is Primary and Non-Contributory.Waiver Subrogation is included per policy form.Ten(10)days prior written notice for non-payment and Thirty(30)days prior
<br /> written notice for policy cancellation shall be provided to City. Tu Tran Digitally signed by
<br /> Tu Tran Nguyen
<br /> Nguyen 121721-08008 APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 12:16 pm, Dec 08, 2025
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Y ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 220 S Daisy Ave
<br /> Santa Ana,CA 92703
<br /> AUTHORIZED REPRESENTATIVE
<br /> �V
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
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